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Need caption for photo of sleeping newborn baby Pediatric Audiology: Before 3 Months

Improvement Strategies


Evaluate both ears

Complete definitive diagnosis BEFORE 3 MONTHS of age

Complete Parent Roadmap for families with a child identified with a hearing loss

Complete the AZ EHDI Patient Checklist (English) or AZ EHDI Patient Checklist (Spanish)  for Primary Care Providers with families who need further screening for hearing loss

Streamline authorization to eliminate delay to specialty providers such as ORL, ENT and genetics

Offer a referral to Guide by your side  or Arizona Hands and Voices

Report Data to the Arizona Department of Health Services

Pediatric Audiology: Introduction

Best Practice Guidelines


Review sample policies, procedures and competency guidelines that align with JCIH Guidelines.

Tools for Improvement


Assure follow-up with a few key data-collection and communication tools.

Improvement in Action


See how the collaboratives used improvement tools to test steps of change within their organizations.

Closing the Follow-up Gap: Pediatric Audiology

Pediatric Audiology: Hearing Loss


Between the newborn period and school age the prevalence of significant hearing loss doubles. This increase in hearing loss is due to:

  • Late onset losses
  • Progressive losses
  • False negative screens
  • Missed newborn screens or loss to follow-up

Although some children present with hearing loss and have no risk factors, there are conditions known to cause hearing loss. The Joint Committee on Infant Hearing recommends that these children receive, at minimum, a diagnostic assessment by 24 to 30 months of age. Risk indicators that are marked with an asterisk are of greater concern for delayed-onset hearing loss and should receive earlier and/or more frequent assessment.

  • Caregiver concern regarding hearing, speech, language, or developmental delay
  • Family history* of permanent childhood hearing loss
  • Neonatal intensive care of more than 5 days or any of the following regardless of length of stay: ECMO*, assisted ventilation, exposure to ototoxic medications (gentimycin and tobramycin) or loop diuretics (furosemide/Lasix), and hyperbilirubinemia that requires exchange transfusion.
  • In utero infections, such as CMV*, herpes, rubella, syphilis, or toxoplasmosis.
  • Craniofacial anomalies, including those that involve the pinna, ear canal, ear tags, ear pits, and temporal bone anomalies.
  • Physical findings, such as white forelock, that are associated with a syndrome known to include a sensorineural or permanent conductive hearing loss.
  • Syndromes associated with hearing loss or progressive or late-onset hearing loss*, such as neurofibromatosis, osteopetrosis, and Usher syndrome. Other frequently identified syndromes include Waardenburg, Alport, Pendred, and Jervell and Lange-Nielson.
  • Neurodegenerative disorders*, such as Hunter syndrome, or sensory motor neuropathies, such as Friedreich ataxia and Charcot-Marie-Tooth syndrome.
  • Culture-positive postnatal infections associated with sensorineural hearing loss*, including confirmed bacterial and viral (especially herpes viruses and varicella) meningitis.
  • Head trauma, especially basal skull/temporal bone fractures* that requires hospitalization.
  • Chemotherapy

Discussion Points

  • How does the care align with diagnostic guidelines and best practices?
  • How is the family engaged?
  • How is care coordinated and communicated?
  • How do you find resources appropriate to this family's needs?
  • What staff training is needed?
  • Which improvement strategies could the medical home have implemented that would have assisted the family in getting to follow-up?
  • What could you do to diminish the impact congenital fluid has on the identification of permanent hearing loss? 
  • What can the audiology practice do to assure a successful evaluation including a full diagnostic ABR?